International journal of cardiology · 2026
ExTRa mapping-derived non-passive activation predicts atrial fibrillation recurrence following pulmonary vein isolation in persistent atrial fibrillation.
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Yajima Kazuhiro, Nakayama Takafumi, Fujiyoshi Kazuma, Sugiura Masato, Ikehara Noriyuki
Аннотация
BACKGROUND: Pulmonary vein (PV) isolation is the cornerstone of catheter ablation for atrial fibrillation (AF), yet its efficacy remains suboptimal in persistent AF, partly due to non-PV drivers. ExTRa Mapping, a real-time phase mapping system, enables visualization of spatiotemporal AF dynamics and identification of non-PV drivers. This study investigated whether ExTRa Mapping parameters predict AF recurrence after PV isolation in persistent AF.
METHODS: Forty consecutive patients with symptomatic persistent AF were enrolled. All underwent extensive PV isolation followed by adjunctive ablation targeting non-PV driver regions identified by ExTRa Mapping.
RESULTS: Mean AF duration was 1.3 ± 2.1 years, and mean follow-up was 2.3 ± 1.8 years. AF recurred in 20 patients. The ExTRa score, defined as the mean of the five highest non-passive activation (%NP) values, was significantly associated with AF recurrence (p = 0.0040). An ExTRa score ≥ 55.8% predicted recurrence with an area under the curve of 0.767 (log-rank p = 0.0012). Patients with the highest %NP localized to the peri-left atrial appendage region had higher recurrence rates than those with non-peri-LAA localization (p = 0.0384). The ExTRa score was significantly associated with recurrence in univariate Cox analysis (HR 4.99, p = 0.0012) and remained an independent predictor in multivariate analysis (HR 7.86, p < 0.0001). Adjunctive ablation of the top five regions did not ensure durable rhythm control.
CONCLUSIONS: The ExTRa score independently predicts AF recurrence after PV isolation in persistent AF and may aid in identifying high-risk patients and optimizing individualized ablation strategies.
METHODS: Forty consecutive patients with symptomatic persistent AF were enrolled. All underwent extensive PV isolation followed by adjunctive ablation targeting non-PV driver regions identified by ExTRa Mapping.
RESULTS: Mean AF duration was 1.3 ± 2.1 years, and mean follow-up was 2.3 ± 1.8 years. AF recurred in 20 patients. The ExTRa score, defined as the mean of the five highest non-passive activation (%NP) values, was significantly associated with AF recurrence (p = 0.0040). An ExTRa score ≥ 55.8% predicted recurrence with an area under the curve of 0.767 (log-rank p = 0.0012). Patients with the highest %NP localized to the peri-left atrial appendage region had higher recurrence rates than those with non-peri-LAA localization (p = 0.0384). The ExTRa score was significantly associated with recurrence in univariate Cox analysis (HR 4.99, p = 0.0012) and remained an independent predictor in multivariate analysis (HR 7.86, p < 0.0001). Adjunctive ablation of the top five regions did not ensure durable rhythm control.
CONCLUSIONS: The ExTRa score independently predicts AF recurrence after PV isolation in persistent AF and may aid in identifying high-risk patients and optimizing individualized ablation strategies.